- The Recovery Revolution: The Battle Over Addiction Treatment in the United States by Claire D. Clark
The Recovery Revolution offers a timely history of addiction treatment in the United State, focusing particularly on therapeutic communities. Claire Clark, a historian with additional training in the behavioral sciences, presents a nuanced study of the rise, development and legacy of the 1960s therapeutic community model and the "recovery movement" it heralded. Beginning with Synanon, a controversial addiction treatment program developed in the late 1950s and popularized through the 1960s, Clark shows how a community-based approach emphasizing "recovery," was subsumed into a greater recovery industry, and into a deeply conservative approach to drug treatment. Clark's meticulous research is matched by her impressive mastery of health policy, past and present, and her study is a valuable contribution not only for historians, but also for policymakers.
The book is organized into three parts: Revolution, Co-optation and Industrialization. In the first section, she describes the rise of Synanon, and how politicians and policy-makers responded to the appearance of a new player in the addiction-treatment field. In "Co-optation," Clark describes the rise of similar therapeutic community programs, which, she explains, in fact "dulled" Synanon's "influence on the addiction-treatment field" (78). She compellingly shows how "second-generation" therapeutic communities broke away from Synanon's leftist, "hippy" image, to work with the Nixon administration. A salient illustration of this is Daytop's adoption of urine drug-tests (as opposed to Synanon's insistence on "rigorous honesty" without surveillance) (81). An additional fascinating aspect of this story is the role of "ex-addicts." Hiring exaddicts became an industry in itself, as a significant majority of graduates from therapeutic communities were subsequently employed by these very same institutions, with varying results.
As Clark expertly unpacks the Nixon-era approach to drug treatment, addressing the spectrum of abstinence, methadone maintenance, and therapeutic community approach, she deftly discusses the role of privatization and deregulation. By the early 1970s, therapeutic communities epitomized the values of American conservatism, transformed from a "counterculture" to a "quarantine ward." Yet to complicate this narrative, Clark introduces us to the "Seed," a Dade County therapeutic community which "promised to transform long-haired, [End Page 1008] pot-smoking, wayward youth into clean-cut, God-fearing citizens (135)." Enjoying significant federal funding, the "Seed" was rife with abuse and lacking in professionalism. As the program closed, the "chaotic period" of expansion in drug addiction treatment, Clark argues, came to an end (138).
In "Industrialization," Clark examines how therapeutic communities developed under the Reagan administration. Predictably, these were under-regulated privatized endeavors that focused on strengthening the nuclear family. By the late 1980s, the Bush administration's director of drug policy, William Bennett, was espousing the perspective of 1960s therapeutic communities (163), while arguing against expanding government-funded treatment. In the final chapter of the book, Clark examines the interplay between therapeutic communities and drug courts, which diverted substance-using offenders into treatment, and preferentially, into abstinence-based therapeutic communities. The concept of "recovery" is the central player in this history, as Clark follows its convoluted history and multiple incarnations. From twelve-step approaches to George W. Bush's Office of Faith Based Initiatives, and finally, to the appointment of Michael Botticelli, a recovering alcoholic (in addition to his public health bone fides), Clark cautiously suggests that the "recovery revolution" might be a "new civil rights movement." Yet, she warns, stories of individual recovery can be "made to serve almost any political agenda," and may often work against the interests of those who are most vulnerable (201).
The somewhat optimistic conclusion brings the readers up to the second Obama administration, and the gains of the Affordable Care Act. As Clark crisply walks the reader through parity laws and essential health benefits, she offers important insights on the cooption of community principles and the newest incarnation of recovery and its ensuing industry: "recovery coaches." Plus ca change. Yet a real "recovery revolution," Clark argues, has still...